Minutes 05.17.12

Minutes 05.17.12

University of Virginia School of Medicine
Curriculum Committee
Minutes – 05/17/12

Pediatric Conference Room, 4:00 p.m.

Present (underlined) were: Gretchen Arnold, Robert Bloodgood, Megan Bray, Chris Burns, Donna Chen, Thomas Gampper, Peter Ham, Donald Innes (Chair), John Jackson, Keith Littlewood, Nancy McDaniel, Mohan Nadkarni, Bart Nathan, Linda Waggoner-Fountain, Casey White, Bill Wilson, Mary Kate Worden,  Jeremiah Garrison,  Brandon Hunter for Nicole Cresce, Guests: Elizabeth Gay, Stuart Lowson, David Moyer, Debra Reed (secretary)

  1. Pulmonary System Review & Plans for 2012.  Elizabeth Gay presented an overview of the UVA NxGen Curriculum System Evaluation Report for the Pulmonary System, Curricular Weeks 57-59. She addressed plans for improvements in 2012.

    Pulmonary System Specific Comments

    1.  System Leadership: The students felt strongly that the system leadership in Pulmonary was responsive, approachable, and genuinely caring of the students. They appreciated that the System Leaders were present and available during the sessions. The students recognized the great effort put forth by Drs. Truwit and Bloodgood and Lowson.

    2.  Materials: Student comments reflect that a significant source of concern for them is the assignment of appropriate resources to aide in their mastery of the learning objectives.  The students have asked for resources that are both appropriate for their level of learning, and manageable in terms of volume.

    3.  Learning Objectives: The students are very sensitive to variations in the quality of the learning objectives. Student comments reflect that the quality of the learning objectives in Pulmonary can improve further in terms of specificity and linking to resources. Faculty support for the development of learning objectives has been offered in the past with only limited success but it is clear from this evaluation that students want learning objectives that are specific and keyed to their educational resources. Additionally, assessment items should be clearly linked to specific learning objectives.

    4.  Clinical Relevance: The students broadly praised Pulmonary for its clinical relevance and focus. The students are sensitive to and supportive of the effort made to maximize the clinical relevance of the material presented to them. It serves a continual reminder of why they are medical school, and helps support their professional development. This effort should be continued in both the Systems, and in CPD.

    5.  System Organization: The students felt the ordering and overall organization of Pulmonary was supportive of their learning. They appreciated the effort made to introduce “normal” first before diving into the “abnormal.” One suggestion for improvement is to continue to refine sessions so that they are not rushed or so they do not go over the time allotted.

    6.  Practice: The students appreciate any effort for additional practice questions or review.

    Elizabeth Gay, Stuart Lowson, David Moyer, Bob Bloodgood and Jonathon Truwit learned much from the report and identified changes that should improve the educational product for students in the Class of 2015. Bob Bloodgood brought his great experience and organizational skills as course director to the Pulmonary System where he worked closely with Jonathon Truwit and Stuart Lowson. The 2012 Pulmonary System will be organized and run by a new team Elizabeth Gay, Stuart Lowson, and David Moyer. Based on the above report they have been working to: 

    1.  The Sequence of the System. The sequence of topical flow through the system appeared to work well last year and so will remain largely unchanged. One exception is the move of the pathology laboratory to the last week after the students have had readings, discussions and lectures and where the laboratory can serve as a synthetic summary. There will be an internal assessment for the laboratory.

    2.  Improve Learning Objectives.  The learning objectives were broad and not always tied to specific identified Learning Materials.  The Pulmonary System Leaders are working with Casey White to review and improve the learning objectives. Consistency in format for LOs across educational units is the goal. LOs will checked against appropriate and available resources. Test questions will be linked to a learning objective. Prior topics will be integrated into the formative and summative exams at the 10-15% mark, as per NexGen guidelines.

    3.  Improve Integration of Material from Previous Systems. Examples are control of breathing and sleep apnea from MBB.

    4. Improve Quality of Learning Resources.   The resources must be at the appropriate level of understanding as well as appropriate length for pre-clerkship medical students allowing for manageable preparation. Handouts as supplements to the readings either as concise overviews (highlighting information that is most pertinent) or explanations of difficult concepts can assist studying and increase efficiency.

    5.  Assessment. Although some students were concerned by the large number of small formatives this is an important part of the curriculum and should be continued. Please see System Guidelines. Additional assessment practices:

    Increase feedback to make formative assessments a better learning experience, especially for on‐line assessments
    Technical problems with assessment for grading
    Notifying students in advance about the specifics of the small assessments
    Some of the assessment questions were too difficult (too much higher level clinical thinking).
    Use USMLE style questions.
    More practice quizzes on the organ system web site. See System Guide.
    Continue well-received end‐of‐week comprehensive/integrative review sessions

    The Committee seconds the Pulmonary System as an example of integration of basic science (especially physiology) with clinical issues. Physicians in this area are always using basic science and thinking about it and this came out in the System. The physicians were consistently modeling for the medical students the application of basic science. Hence, the physicians were presenting and reinforcing basic science issues in the Pulmonary System as much as the basic scientists (this could be said for gross anatomy, pathology, histology and cell biology, as well as physiology, albeit the latter was the dominant basic science). In addition, we feel that the Pulmonary System did accomplish the goal of preparing the medical students for the Clerkship in terms of clinical thinking and clinical skills in this area.

    The Committee is satisfied with the 3-week length of the Pulmonary System, but encouraged the further development of inter-system collaboration especially between the Cardiovascular and Pulmonary Systems. Fusion of the Cardiovascular and Pulmonary Systems into a single 7-week system should be considered for 2013.

    There can be no afternoon system classes or laboratories. Pre-Recorded Lectures should be used when appropriate, but not to excess. If more than four hours of Pre-Recorded Lectures are assigned then equivalent self-study time must be provided in the morning hours.

    Other areas for improvement include:
    a. Pharmacology basic science lecture (content and delivery)
    b. Alternative and Complementary Therapies (problem with the web site assigned, the extent and breadth of the readings and a lack of focus on the pulmonary area).  However, we do feel that this is an area that should be represented in the curriculum.

    The Committee thanked the System Leaders Elizabeth Gay, Stuart Lowson, and David Moyer as well as Bob Bloodgood and Jonathon Truwit for their work in this ever evolving system.  The Committee endorsed the proposed recommendations for improvement.

  2. Microsurgical Training. The Committee was asked to review the educational benefits and goals (learning objectives) and approve or disapprove the Microvascular and Microneural Anastomosis for undergraduate medical education. The curriculum, the education activities, and the necessity for animals was reviewed in accordance with the policy – Use of Live Animals in Medical Education, Office of the Vice President for Research. The Curriculum Committee members had the protocol in advance for review.

    From the protocol abstract one can conclude that the following are the learning objectives.
    1.  The medical student should be proficient in the use of the operating microscope.
    2.  The medical student will develop dexterity and hand eye coordination [prior to using the rat model].
    3.  The medical student should be proficient in the repair of extremely delicate structures [prior to human surgery].

    A discussion ensued in which the educational value of medical students learning anastomosis on live animals was debated but generally judged minimal. Several also felt the protocol involving medical student teaching potentially placed the school at risk. The general consensus was that there was no need to train medical students using rats given the medical student introductory level of training and responsibility, especially since no student would be allowed to use the technique in patient care. Different was practicing anastomosis on live animals prior to human surgery by resident or fellow-level physicians. The protocol should be revised and submitted to the GME Committee for review.   The Plastic Surgery Department may wish to consider the “Microvascular Anastomosis Training Model Based on a Turkey Neck with Perfused Arteries”   Neurosurgery 62(ONS Suppl 2): ONS407-ONS411, 2008 for medical student use.

    In summary, the Committee found no compelling educational reason for medical students to learn anastomosis on live animals. [7 for disapproval; 2 abstentions]

Donald J. Innes, Jr., M.D.